The completed application form MUST be accompanied by: a copy of the course outline, schedule or agenda Please allow up to 10 weeks' response time for approval. Incomplete applications may lead to delayed approval. The nominated contact will be notified in writing once approval has been granted. Organisers of CPD approved events are required to: keep a record of the names of attendees for a minimum of five years provide attendance certificates to participants who require them If the same event is being held on multiple occasions (within one year from the date of the first occurence) then one application fee will cover all meetings as long as a full list of dates is included with this application. Event Title Existing Contact Providing Organization Street Address Street Address Line 2 Street Address Line 3 City Postal Code Start Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068 End Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068 Number of hours’ learning time (excluding registration and breaks) Sponsor(s) (if any) Venue Course Provider Type * - Select -CommercialNon-Commercial Please note that non-commercial course providers may be asked to provide evidence of their not-for-profit status Website Listing for this event * Yes No There is an additional fee for including this event under Event listing on the Faculty website. Newsletter listing for this event * Yes No There is an additional fee for including this event under Event listing on the Faculty website. Nominated Contact First Name Last Name Email Phone Number Signed * Date Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20162017201820192020
